Dr. Carmen Guerra, Assistant Professor of Medicine, Division of General Medicine, University of Pennsylvania, is applying for an NCI Mentored Career Development Award for Underrepresented Minorities (K01) to develop and enhance the skills necessary for an academic career as a successful, independent, cancer control investigator. Dr. Guerra currently is the recipient of a Minority Supplement sponsored by the Agency for Health Care Research and Quality, through which she has initiated a rigorous research training program and begun her transition from a faculty career in clinical medicine to one focused on research. Dr. Guerra has enrolled in courses towards a Master's of Science Degree in Clinical Epidemiology (M.S.C.E.) and initiated two mentored projects in cancer screening. This CDA will allow her to build on the research foundation she has initiated. Through the resources provided by the NCI CDA, Dr. Guerra will complete the M.S.C.E. degree requirements receive intensive research and career mentoring in clinically related cancer prevention research, conduct a series of linked studies informing understanding of barriers to and facilitators for physician initiated colorectal cancer screening (CRCS) and prepare, submit and hopefully receive independent peer-reviewed funding. CRCS is severely underutilized. Only 20.6 percent of adults over 50 have performed fecal occult blood testing; only 33.6 percent have completed a flexible sigmoidoscopy in accordance with clinical guidelines (1, 14-18). Only half the eligible population has received a recommendation from their current physician to undergo CRCS (2). Yet physician recommendation is one of the strongest predictors of patient adherence with CRCS (2-6). It is not fully understood why, despite the evidence that supports CRCS and generally consistent CRCS clinical practice guidelines, physicians are not recommending CRCS more frequently. In this application, Dr. Guerra proposes to identify and better characterize the barriers to and facilitators of physician recommendation of CRCS, combining qualitative studies to identify the barriers and facilitators in conjunction with a nation-wide physician survey that will help to generate hypotheses about the factors associated with physician recommendation of CRCS. Understanding the barriers to CRCS recommendation is an essential step in developing and implementing effective physician CRCS interventions that will significantly reduce CRC incidence, morbidity and mortality.